IS ABDOMINAL-CAVITY CULTURE OF ANY VALUE IN APPENDICITIS

BACKGROUND: Intraperitoneal culturing during appendectomy is a routine procedure. Significant decrease in the mortality and dramatic improve ment in the morbidity were achieved by using antibiotics perioperative ly. The value of intraoperative abdominal cavity culture was assessed in our study. METHODS: A total of 499 patients formed two groups, thos e with acute nonperforated appendicitis (group A) and those with perfo rated appendicitis (group B). Intraoperative abdominal cavity culture were taken randomly in both groups. The perioperative morbidity, the v alidity, and the impact of positive culture on the antibiotic treatmen t were examined in both groups. RESULTS: Clinical diagnosed perforatio n was confirmed histologically in 176 patients (98.3% accuracy). Intra peritoneal cultures were obtained in 30.1% of the patients in group A and in 67.1% of group B. The majority of the patients in group A were treated preoperatively and postoperatively by a single antibiotic agen t whereas 58.0% of the patients in group B were started on triple-agen t antibiotics for significantly longer periods (22.4 +/- 9.4 versus 5. 7 +/- 7.4 doses, respectively; P < 0.0001). No significant difference was found in both groups in the postoperative complication rate (wound infection, intra-abdominal abscess and small bowel obstruction) wheth er intra-abdominal culture was obtained or not (5.9% versus 4.7% in gr oup A and 21.2% versus 21.9% in group B; P > 0.05), CONCLUSION: Tradit ional intraoperative abdominal cavity culture can be abandoned. In per forated appendicitis, colonic flora can be predicted, and antibiotic t herapy should begun without any abdominal cavity culture results. This practical approach will save money and reduce laboratory work without affecting the patient's morbidity. (C) 1998 by Excerpta Medica, Inc.